1669740247 NPI number — MISS LORRAINE ANN-MARIE SWABY PHYSICIAN ASSISTANT

Table of content: MISS LORRAINE ANN-MARIE SWABY PHYSICIAN ASSISTANT (NPI 1669740247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669740247 NPI number — MISS LORRAINE ANN-MARIE SWABY PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWABY
Provider First Name:
LORRAINE
Provider Middle Name:
ANN-MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669740247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22224 LA PALMA AVE STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORBA LINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92887-3819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
741-692-7140
Provider Business Mailing Address Fax Number:
714-696-7767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22224 LA PALMA AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORBA LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92887-3819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-692-7140
Provider Business Practice Location Address Fax Number:
714-696-7767
Provider Enumeration Date:
12/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA21964 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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